Falls Flashcards
What causes a fall?
Intrinsic = vision, cognition, CVS, infection, neuropathy, myopathy, surgery, arthritis, seizures, dementia
Extrinsic = medications, incorrect/no walking aids, environment (accommodation, floor covering, lighting, furniture, pets, weather), glasses, footwear, hearing aids, other people, activity at the time, medication
What medications put a pt at increased risk of falls?
Diuretics = BP drop, electrolyte imbalance
Abx = diarrhoea, rush to toilet
Parkinson’ s
Anaesthetics = confusions, regional block
Anti-HTN
Anti-histamine
Laxative = diarrhoea
Insulin overdose = low glucose
Gliclazide
Rate limiters = beta blockers
SSRI = postural hypotension
Stain = myopathy, myalgia
Alpha blockers = tamsulosin, vasodilation
Side effect of confusion
Pain relief
Anti-anxiety - diazepam
What questions should be asking when Hx a falls pt?
When, where, witness?
Injury?
Other symptoms - postural dizziness (BP prob), positional dizziness (turned, vestibular problem), palpitations
Previous falls?
Ask about stairs - rails, floor covering
Footwear - examine feet as well
Glasses - near/distance vision, distort visual fields (recommend single vision lenses)
What their normal situation is (holistic view)
Explore any fear
Why presenting to A+E?
How should a fall be investigated?
Examination = CVS, resp, CN, upper/lower limbs, vestibular, abdo, AMTS/CAM, vision, knee exam, feet/footwear, get-up-and-go, home hazards
Bloods = FBC, glucose, U+Es, LFTs, bone profile, TFT, b12/folate, HbA1C, vit D (myopathy)
ECG = arrhythmia, MI
Urine dip = (don’t dip if >65 due to asymptomatic bacteriuria) - MSU
Postural BP (manual sphig) = lay down for 5, stand BP, then stand for 1 and 3 min BP
24hr ECG
ECHO = murmur
CT head = looking for bleed (particularly if on anti-coag)
Bone health + fracture risk assessment = FRAX tool
How should a fall be managed?
Medication review = do they need all meds, are they taking them correctly
Treat a reversible cause
Bone health and fracture risk management
MDT review
Refer to falls clinic if >2/year
Physiotherapy = walking aids, strength and balance training, fall prevention programme
Occupational therapy = environmental adaptations, functional assessments
Postural hypo = fludocortisone
How is orthostatic hypotension treated?
Med reduction/withdrawal = antihypertensive, alpha blockers, antidepressants
Adequate salt/water intake
Fludrocortisone (salt and water retention)
What are the risk factors for osteoporosis?
- Women
- Age
- FH
- Early menopause
- Vit D, calcium def
- Malnutrition
- Smoking
- Low body weight
- Caucasian
What medications are used to treat osteoporosis?
Colecalciferol with calcium
Bisphosphonates (alendronate, risedronate, zoledeonate)
Parathyroid hormones
Calcitonin
HRT